States that opposed Obamacare, like Michigan, may have made it more efficient

That's one of the lessons drawn from a report put out by the law firm Mehri & Skalet.

The author of the report, Jay Angoff, once led the U.S. Health and Human Services office in charge of implementing the Affordable Care Act.

Angoff looked at the amount it cost to set up health care exchanges in each state along with the number of enrollees in each state through March 31, 2014.

By doing that, he came up with a “cost-per-enrollee” for each state’s health care exchange.

Overall, the average cost-per-enrollee was $922. The average cost was higher for states with their own exchanges, and lower in states with the federally-run exchange.

"...state officials refusing to establish their own Exchanges appear to have unwittingly contributed to the efficient implementation of the Exchange in their states."

You might recall that many states resisted implementing the Affordable Care Act. Some attorney generals in those states even sued to try to stop it. As a result, 36 states have exchanges run by the federal government.

Michigan was among those states whose Legislature and AG tried to stop the federal health care law. Gov. Snyder wanted legislators to set up a state-run exchange, but they refused.

By doing so, Angoff’s report notes:

… state officials refusing to establish their own Exchanges appear to have unwittingly contributed to the efficient implementation of the Exchange in their states.

Michigan was among the most efficient states in terms of the amount it spent for each person who enrolled.

Here are the top five states for “cost-per-enrollee” (all resisted implementation of the ACA):

Florida $76

Texas $102

Georgia $240

Virginia $376

Michigan $427

And here are the five areas with the most expensive “cost-per-enrollee” (two opposed the ACA):

Hawaii $23,899

District of Columbia $12,467

North Dakota $7,089

Delaware $6,825

Wyoming $6,323

Obviously, “cost-per-enrollee” is going to be higher in states with smaller populations, as is the case with several of the states above.

The overall message, states might want to consider switching to the federal system.

Angoff said it does make sense to let states whose exchanges are functioning well to continue, but the federal government might want to reconsider letting other states establish their own exchanges, and encourage those whose exchanges aren't doing so well to become part of HealthCare.gov.